Provider Demographics
NPI:1760441562
Name:COBB COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:COBB COUNTY BOARD OF HEALTH
Other - Org Name:SMYRNA PUBLIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/ ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-514-2300
Mailing Address - Street 1:1650 COUNTY SERVICES PKWY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4010
Mailing Address - Country:US
Mailing Address - Phone:770-514-2361
Mailing Address - Fax:770-514-2811
Practice Address - Street 1:3001 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7874
Practice Address - Country:US
Practice Address - Phone:770-438-5105
Practice Address - Fax:770-427-8812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBB COUNTY BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003206293AMedicaid
GA003201625AMedicaid
GA003201568AMedicaid
GA003201632AMedicaid